The First Nationally Representative Benchmark of the Local Governmental Public Health Workforce: Findings From the 2017 Public Health Workforce Interests and Needs Survey

What Predicts Graduate Public Health Student Success? Evidence for Admission Committees in a Post-Affirmative Action Landscape

OBJECTIVE

A severe staff shortage and a dearth of professionals from underrepresented backgrounds in the public health workforce are contributing to poor health outcomes in the United States. Schools and programs can mitigate these problems by admitting more graduate public health students overall and from underrepresented backgrounds. We identified predictors of foundational graduate public health course grades and graduate grade point average (GPA), sharing evidence to remove application factors that are admission barriers and do not predict student outcomes.

METHODS

We conducted a linear regression analysis on demographic and academic factors from 564 graduate public health applications for students at the University at Buffalo who received their degree from January 1, 2016, to February 1, 2021, analyzing age, race and ethnicity, sex, income, undergraduate degree, verbal and quantitative Graduate Record Examination (GRE) percentiles, and undergraduate GPA. Outcomes were grades in foundational public health courses and cumulative graduate GPA.

RESULTS

Undergraduate GPA was the best predictor of graduate public health student success, explaining nearly 7% of foundational public health course grades and 29% of graduate GPA. Higher undergraduate GPA contributed to higher course grades and graduate GPA. GRE scores explained <1% of student outcomes.

CONCLUSIONS

Our findings add to the growing body of research showing that standardized test scores may not predict graduate student outcomes and provide further evidence for the field of public health to consider removing this admission barrier. By doing so, institutions could admit more students to graduate public health programs who can bring needed skills to the market, further diversifying the workforce and public health faculty, to better meet population health needs.

On-the-Job Learning: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response

This article is one of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the governmental public health workforce's pandemic response. Using PH WINS 2021 data, we qualitatively examined responses to an open-ended survey question about workforce experiences during the pandemic response. On-the-job learning was emphasized as a critical component of employees' experiences. Seven "on-the-job learning" subthemes were identified among 91 responses. Findings indicate that the pandemic facilitated opportunities for on-the-job learning for various skills and workplace activities. Public health employees were appreciative of the opportunity to gain new technical and practical skills including communicating with the public and to experience new roles and responsibilities. Respondents reported other related benefits including career growth and leadership opportunities. Highlighting these unexpected benefits of the COVID-19 pandemic is important for employee morale and continued workforce development planning.

Practices Among Local Public Health Agencies to Support Evidence-Based Decision Making: A Qualitative Study

OBJECTIVES

Evidence-based decision making (EBDM) capacity in local public health departments is foundational to meeting both organizational and individual competencies and fulfilling expanded roles. In addition to on-the-job training, organizational supports are needed to prepare staff; yet, less is known in this area. This qualitative study explores supportive management practices instituted as part of a training and technical assistance intervention.

DESIGN

This qualitative study used a semistructured interview guide to elicit participants' descriptions and perceptions via key informant interviews. Verbatim transcripts were coded and thematic analyses were conducted.

SETTING

Local public health departments in a US Midwestern state participated in the project.

PARTICIPANTS

Seventeen middle managers and staff from 4 local health departments participated in remote, audio-recorded interviews.

INTERVENTION

Following delivery of a 3½-day in-person training, the study team met with health department leadership teams for department selection of supportive agency policies and procedures to revise or newly create. Periodic remote meetings included collaborative problem-solving, sharing of informational resources, and encouragement.

MAIN OUTCOME MEASURES

Included management practices instituted to support EBDM and impact on day-to-day work as described by the interview participants.

RESULTS

Leadership and middle management practices deemed most helpful included dedicating staff; creating specific guidelines; setting expectations; and providing trainings, resources, and guidance. Health departments with a preexisting supportive organizational culture and climat e were able to move more quickly and fully to integrate supportive management practices. Workforce development included creation of locally tailored overviews for all staff members and onboarding of new staff. Staff wanted additional hands-on skill-building trainings. Several worked with partners to incorporate evidence-based processes into community health improvement plans.

CONCLUSIONS

Ongoing on-the-job experiential learning is needed to integrate EBDM principles into day-to-day public health practice. Management practices established by leadership teams and middle managers can create supportive work environments for EBDM integration.

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.

Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize?

OBJECTIVE

This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps.

DESIGN

Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data.

SETTING

State and local health departments.

PARTICIPANTS

Nationally representative population of state and local governmental public health workers.

MAIN OUTCOME MEASURES

Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response.

RESULTS

For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered.

CONCLUSIONS

A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes

CONTEXT

Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes.

PROGRAM

CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes.

IMPLEMENTATION

From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert-led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact.

EVALUATION

Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%).

DISCUSSION

The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff.

Perceptions of Barriers: An Examination of Public Health Practice in Kansas

Public health and healthcare professionals perform a wide variety of services for their communities, and serve in important and often overlapping roles, particularly in rural communities. In this qualitative study, public health practitioners in Kansas were asked about their perceptions of barriers to public health and vulnerable people in their communities. Participants from across Kansas were interviewed via teleconferencing, telephone, or email, and emergent themes were identified using qualitative thematic analysis. While asked about public health specifically, during interviews, many participants discussed barriers to healthcare as well. The top barriers to effective public health practice identified in this study were funding, education, accessibility, and affordability. Others included politics, transportation, and the need to expand Medicare and Medicaid. The populations believed most vulnerable in their communities were community members living in poverty, elderly people, and other marginalized populations. Our findings suggest public health practitioners in Kansas observe a lack of understanding and knowledge in their communities about public health, along with the recognition that a lack of accessibility and affordability to health services are barriers to effective public health practice.

Core Competency Gaps Among Governmental Public Health Employees With and Without a Formal Public Health Degree

OBJECTIVES

To examine the role of a formal public health degree as it relates to core competency needs among governmental public health employees.

DESIGN

This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting χ tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, highest degree attained, current employer, role type, tenure in current agency, and public health certificate attainment constant.

SETTING

Nationally representative sample of government public health employees.

PARTICIPANTS

A total of 30 276 governmental public health employees.

MAIN OUTCOME MEASURE

Self-reported competency skills gaps.

RESULTS

Among nonsupervisors, those with a public health degree had significantly lower odds of reporting a competency gap for 8 of the 21 skills assessed. Among supervisors/managers, those who had a formal public health degree had significantly lower odds of reporting a competency gap in 3 of the 22 skills assessed. Having a degree in public health was not significantly related to an executive's likelihood of reporting a skill gap across any of the 22 skills assessed. Regardless of supervisory level, having a public health degree was not associated with a reduced likelihood of reporting skill gaps in effective communication, budgeting and financial management, or change management competency domains.

CONCLUSIONS

Possessing a formal public health degree appears to have greater value for skills required at the nonsupervisor and supervisor/manager levels than for skills needed at the executive level. Future work should focus on longitudinal evaluations of skill gaps reported among the public health workforce as changes in public health curricula may shift over time in response to newly revised accreditation standards. In addition, public health education should increase emphasis on communication, budgeting, systems thinking, and other management skills among their graduates.

Flexibility and partnerships perceived as supportive of dual hazard response: COVID-19 and heat related illness, Summer 2020

OBJECTIVES

To understand how health departments implemented the response to the dual hazards of Heat Related Illness (HRI) and COVID-19 in Summer 2020.

METHODS

We interviewed five health jurisdictions with a Building Resilience Against Climate Effects (BRACE) Framework HRI project to understand impacts to organizational roles and preparedness activities, capacity to respond to the heat season, challenges experienced with resources and personnel, and how partners influenced their capacity to respond to dual hazards.

RESULTS

Health jurisdictions working in both heat preparedness and on the COVID-19 response highlighted three components as integral to maintaining public health capacity throughout the pandemic: 1) adapting to changing roles and responsibilities, 2) building and strengthening inter-organizational partnerships, and 3) maintaining flexibility through cross-training as themes to maintain the public health capacity throughout the pandemic.

CONCLUSIONS

With impacts of the changing climate, including resultant extreme events with subsequent public health impacts, simultaneous responses are likely to arise again in the future. Developing cross-training programs, fostering flexibility and adaptability within the workforce, and building and sustaining external partnerships can support health departments anticipating the need to respond to simultaneous public health hazards in the future.

Determinants of workplace perceptions among federal, state, and local public health staff in the US, 2014 to 2017

Background

The governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce.

Methods

Workforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response.

Results

In 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p < .0001); and 62% vs 52% in HHS (p < .0001). Among state staff, intent to leave increased from 22 to 31% (p < .0001), but fell in 2017 from 33 to 28% for HHS (p < .0001). Correlates of intent to leave included low job satisfaction, pay satisfaction, and agency type. Federal entities saw the highest proportion respondents that indicated they would recommend their organization as a good place to work.

Conclusions

While intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11703-x.

Evaluation of Training Gaps Among Public Health Practitioners in Washington State

CONTEXT

Identifying training gaps in public health competencies and skills is a first step in developing priorities for advancing the workforce.

OBJECTIVE

Our purpose was to identify training gaps in competencies and skills among local, state, and nonjurisdictional public health employees in Washington State. Our secondary aim was to determine whether training gaps differed by employees' work-related and demographic characteristics.

DESIGN

We used data from our training needs assessment of the public health workforce, conducted as an online cross-sectional survey in Spring/Summer of 2016.

RESPONDENTS AND SETTING

Employees from governmental local, state, and nonjurisdictional public health departments in Washington State.

MAIN OUTCOME MEASURES

Training gaps were calculated for 8 public health competencies and 8 skills, using a composite score of respondents' ratings of their "training confidence" and "training need." For each domain and skill area, we calculated the percentage of associated items, where respondents rated their training needs as high and their confidence as low to create scores ranging from 0% to 100%.

RESULTS

The largest training gaps in public health competencies were in the Financial Planning and Policy Development domains. For skills, Quality Improvement and Developing Effective Communication Campaigns had the largest training gaps. In adjusted models, female employees or employees working in local health departments in select Washington State regions had higher training gaps in Financial Planning, Policy Development, and Quality Improvement, relative to male or state health department employees. Employees who worked in specialized programs, such as Communicable Disease Control, and Maternal, Child, and Family Health, had higher training gaps in Financial Planning and Developing Effective Communication Campaigns than those who worked in Administrative and Support Services.

CONCLUSIONS

We identified important training gaps in several competency domains and skills. Findings are informing decisions about tailoring training opportunities for public health practitioners in Washington and other states.

Public Health Employees' Perceptions about the Impact of Emerging Public Health Trends on Their Day-to-Day Work: Effects of Organizational Climate and Culture

Objective: The purpose of this research was to assess the workforce characteristics associated with public health employees' perceived impact of emerging trends in public health on their day-to-day work. Methods: Multinomial logistic regression was performed to analyze data from the 2017 PH WINS, a cross-sectional survey utilizing a nationally representative sample of the United States public health workforce. Results: More than 55% of the public health workforce perceived that their day-to-day work was impacted by the emerging public health trends. Workplace environment was significantly associated with the perception of their day-to-day work being impacted by emerging public health trends such as quality improvement (QI) (AOR = 1.04, p < 0.001), and evidence-based public health practice (EBPH) (AOR = 1.04, p < 0.001). Race, ethnicity, and educational status were also positively associated with the perceived impact of the emerging public health trends. Conclusions: The organizational culture of a public health agency influences the engagement of the workforce and their perception of the meaningfulness of their work. As practitioners shift into chief health strategists, it will be imperative for them to have training in public health foundations and tools in order to efficiently serve their communities.

Exploring the Benefits and Value of Public Health Department Internships for Environmental Health Students

Internships are an essential component of preparing prospective college graduates for entering the practice-based field of environmental health (EH). EH professionals continually encounter events or hazards of high complexity and impact, and many experienced EH professionals are expected to retire within the next several years. Efforts are needed to ensure a supply of highly qualified and prepared graduates is available to sustain and strengthen the EH workforce. The National Environmental Public Health Internship Program (NEPHIP) addresses this need by supporting health department internships for EH students of academic programs accredited by the National Environmental Health Science and Protection Accreditation Council. We conducted an assessment to examine former NEPHIP intern and mentor experiences and perspectives on 1) how well the internships prepared interns for careers in EH and 2) to what extent the internships provided value to the host health department. Overall, the internships appeared to provide EH students with a well-rounded professional and practice-based experience, while health departments benefited from hosting interns with a foundational knowledge and college education in EH. Promoting the value of public health department EH internships could encourage more students and graduates to seek internship or employment opportunities with health departments, ultimately strengthening the EH workforce.

Making a Living in Governmental Public Health: Variation in Earnings by Employee Characteristics and Work Setting

CONTEXT

This article examines factors related to earnings in the context of the governmental public health system's urgent need to recruit and retain trained public health workers as many in the existing workforce move toward retirement.

METHODS

This article characterizes annualized earnings from state and local public health practitioners in 2017, using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), which was fielded in fall/winter 2017 to more than 100 000 state and local public health practitioners in the United States. The response consisted of 47 604 public health workers for a response rate of 48%.We performed descriptive statistics, bivariate analyses, and interval-based regression techniques to explore relationships between annualized earnings, supervisory status, gender, years of experience, highest degree (and whether it was a public health degree), job classification, race/ethnicity, union/bargaining unit, paid as salary or hourly wage, setting, and region.

RESULTS

Higher supervisory status, higher educational attainment, white non-Hispanic race/ethnicity, male gender, salaried employment, bargaining unit (labor union) position, certain geographic regions, having a clinical/laboratory/other scientific position, and working in either a state health agency (SHA) or a large local health department (LHD) setting are all associated with higher salary. Having a public health degree versus a degree in another area did not appear to increase earnings. Being a person of color was associated with earning $4000 less annually than white peers (P < .001), all else being equal. The overall regression model showed a gender wage gap of about $3000 for women (P = .018). Supervisors, clinical and laboratory staff, public health sciences staff, and union staff also earned more than their counterparts.

DISCUSSION

As multiple factors continue to shape the public health workforce, including increasing racial/ethnic diversity, continued retirements of baby boomers, and the growth of bachelor's-level public health education, researchers should continue to monitor the gender and racial/ethnic pay gaps. This information should help the field of governmental public health as it endeavors to rebuild its capacity while current workers, many at the highest level of leadership, move on to retirement or other jobs. Public health leaders must prioritize equitable pay across gender and race/ethnicity within their own departments as they build their organizations' capacity to achieve health equity.

The Public Health Workforce Interests and Needs Survey (PH WINS 2017): An Expanded Perspective on the State Health Agency Workforce

Context:

Workforce surveillance efforts have long been called for in public health: the Public Health Workforce Interests and Needs Survey (PH WINS) answers that call.

Objective:

To characterize the state of the governmental public health workforce among State Health Agency-Central Office (SHA-CO) staff across the United States.

Design:

The SHA leadership were contacted and invited to have their agency participate in PH WINS 2017 as a census-based fielding. Participating agencies provided staff lists, and staff were then directly invited by e-mail to participate in a Web-based survey. Pearson and Rao-Scott χ² analyses are employed in descriptive analyses. Balanced repeated replication weights account for design and nonresponse.

Setting and Participants:

SHA-CO staff.

Main Outcome Measures:

The PH WINS focuses on 4 primary domains: perceptions of workplace environment and job satisfaction, training needs, national trends, and demographics. In addition, measures of intent to leave and employee burnout are analyzed.

Results:

The state governmental public health workforce is primarily female (72%), non-Hispanic white (64%), and 46 years of age or older (59%). Nearly one-third (31%) of the workforce is older than 55 years, with 9% aged 30 years or younger. Overall, 74% of respondents indicated that they had at least a bachelor's degree, and 19% indicated having a public health degree of some kind. Seventy-nine percent of the respondents indicated that they were somewhat/very satisfied with their jobs. Approximately 47% of SHA-CO staff say that they are considering leaving or are planning to retire. With respect to training needs, the largest overall gaps for the state health agency workforce were observed in budget and financial management, systems and strategic thinking, and developing a vision for a healthy community.

Conclusions:

PH WINS represents the first nationally representative survey of governmental public health staff in the United States. It holds potential for wide usage from novel workforce research to identifying and helping address practice-based needs.

Master's-Level Education in the Governmental Public Health Workforce

OBJECTIVES

More than 16 000 graduate degrees in public health are awarded annually. Yet only 14% of the governmental public health workforce has formal public health training of any kind, and 8% has a master of public health (MPH) degree. We characterized the differences among governmental staff members with master's degrees across US health departments.

METHODS

We used data from the 2017 Public Health Workforce Interests and Needs Survey, a national survey of state and local public health departments (43 669 responses; response rate, 48%). We examined the characteristics of the workforce by educational attainment and compared respondents who had obtained a "terminal" (ie, highest degree obtained) MPH degree with respondents who had obtained a terminal non-public health (non-PH) master's degree.

RESULTS

Respondents who had a non-PH master's degree were as likely as respondents who had an MPH degree to hold a supervisory role (43% vs 41%; P = .67). We found only 1 significant difference between the 2 groups: respondents aged ≤40 with a terminal MPH degree were significantly less likely than respondents aged ≤40 with a non-PH master's degree to earn more than the national average salary (adjusted odds ratio = 0.67; 95% CI, 0.47-0.97; P = .03).

CONCLUSIONS

We found only marginal differences in career outcomes for people working in governmental public health who had a terminal MPH degree vs a terminal non-PH master's degree. This finding does not necessitate a full reconsideration of the MPH as it relates to governmental public health practice but a greater recognition that there are multiple paths into practice.

Inflammatory and immunological changes caused by noise exposure: A systematic review

Today, due to the growth of industries and spread of the use of various instruments and devices that produce high noise levels, it is necessary to pay more attention to the effects of exposure to noise on organs and tissues in the body. The importance of the immune system in fighting external and pathogenic factors has raised the need to consider external factors (such as harmful physical factors) and make efforts to avoid producing them. In this systematic review, 811 potentially relevant studies were found in Google Scholar, PubMed, and Web of Science databases, of which 32 different English-written articles were included in the study. The method of searching and systematically reviewing articles was based on the assessment tool of the multiple systematic reviews (AMSTAR) method. The results of this study suggested that noise could affect the function of the immune system and its components by affecting other systems and organs of the body, including the central nervous system, auditory system, circulatory system, and endocrine gland. Moreover, it can be hypothesized that noise affects immune system by producing the NADPH oxidase (Nox) and reactive oxygen species (ROS).